La scoliose lombaire dégénérative − Relation entre la clinique, la statique rachidienne, la dégénérescence discale et musculo-ligamentaire : analyse tridimensionnelle par la stéréoradiographie, l’imagerie par résonance magnétique et la tomodensitométrie

Abstract : Adult degenerative scoliosis is a pathology whose prevalence increases with the aging of the population. Moreover, the functional demand is more and more important in these patients. Many studies have shown a benefit of surgical treatment of adult spinal deformity compared to medical treatment in terms of improved functional scores, quality of life and satisfaction. Nevertheless, this surgery is associated with many complications (up to 50% in some series), mostly mechanical such as nonunion, implant rupture, degradation of adjacent levels. Thus, if the radiographic analysis of scoliosis has been well explored, some questions remain like the phenomena responsible for a sudden worsening of the deformation in certain patients or the causes of failures. The aim of this work was to analyze adult scoliosis in 3D using stereoradiography and to evaluate the muscular system of these patients in order to highlight the relationships between spinal deformities, particularly by the horizontal plane analysis, and muscle degeneration.The first part of this work was dedicated to the 3D analysis of scoliosis: first, with the analysis of reproducibility in the adult of 3D stereoradiographic measurements, then by the analysis of the global alignment of these patients with spinal deformity, using a new parameter taking into account the position of the cervico-cephalic junction. After analyzing the postural alignment, the spino-pelvic muscular system was studied in the second part. Indeed, in addition to the alignment of the skeleton, it is the activation of the muscular system that is responsible for maintaining an erect posture. We described the muscular features of patients with lumbar scoliosis and analyzed the relationships with the radiographic parameters of the deformity, showing that depending on the type of deformity some muscle groups were more affected by atrophy and fatty infiltration. Comparing them to young and elderly subjects without deformity, we observed that patients with scoliosis had muscle degeneration that was both related to deformity and aging. In the third part, by linking stereoradiographic posture data with muscular MRI data, we used a personalized musculoskeletal model to better understand the constraints on vertebral segments and therefore to try to explain the mechanical failures.Thus, the combination of 3D radiographic measurements and muscle analysis could better predict muscle degeneration and worsening of deformity and thus prevent it by targeted rehabilitation. For example, a strengthening of the erectors of the spine but also of the flexors could allow better maintaining the posture. And, a strengthening of the erectors and hip flexors could allow activating more effectively, compensation mechanisms such pelvic retroversion. In addition, the demonstration of a musculoskeletal risk factor worsening the deformity would lead to an earlier management of these patients. A longitudinal analysis would be interesting.
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Emmanuelle Ferrero. La scoliose lombaire dégénérative − Relation entre la clinique, la statique rachidienne, la dégénérescence discale et musculo-ligamentaire : analyse tridimensionnelle par la stéréoradiographie, l’imagerie par résonance magnétique et la tomodensitométrie. Médecine humaine et pathologie. Ecole nationale supérieure d'arts et métiers - ENSAM, 2018. Français. ⟨NNT : 2018ENAM0043⟩. ⟨tel-02056377⟩

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